Vacuum assisted surgical stapler

ABSTRACT

A surgical fastener applying apparatus includes an anvil half-section and a cartridge-receiving half-section including an elongated channel member having a pair of opposed openings defined through sidewalls thereof. A disposable assembly including a single use loading unit and a single use firing unit is configured to be releasably supported within the cartridge-receiving half-section. The disposable assembly includes a stationary housing for supporting the firing unit which includes a distal extension for supporting the single use loading unit. The stationary housing includes a pair of flared tabs configured to be releasably received within the openings of the cartridge-receiving half-section to releasably engage the disposable assembly within the cartridge-receiving half-section.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.10/540,197, filed Jun. 20, 2005, which is a National Stage Entry under35 U.S.C. §371(a) of International Patent Application No.PCT/US03/41068, filed on Dec. 22, 2003, which claims the benefit of, andpriority to, U.S. Provisional Patent Application Ser. No. 60/435,223,filed on Dec. 20, 2002, now expired, the entire content of each of theapplications identified above being incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to surgical instruments, e.g., surgicalfastener or stapler apparatus and, more particularly to circularsurgical staplers for performing surgical procedures, including but notlimited to rectal mucosectomies, rectal anopexies, anastamoses,hemorrhoidectomies, or the like. In addition the present disclosurerelates to methods of performing such surgical procedures.

2. Background of Related Art

Various types of surgical fastener applicators and/or staplers are knownfor the application of fasteners or staples to tissue in order to joinadjacent tissues. For example, it is known to use various types ofstaplers in gastric and esophageal surgery, in both classic or modifiedgastric reconstructions performed end-to-end, end-to-side, orside-to-side, as well as for performing a hemorrhoidectomy.

Hemorrhoids are a mass of dilated veins in swollen tissue at the marginof the anus or nearby within the rectum. Typically, hemorrhoids arecaused by chronic straining for example from constipation and/orchildbirth. The plexus of vascular tissue beneath the epithelial liningof the anal canal is called the corpus cavemosus recti or anal cushion.The plexus connect arteries to veins without intervening capillariesthus creating the vascular component of the anal cushions. Thesearteriovenous channels control the size of the anal cushions byregulating the blood volume flowing through them. Chronic strainingdamages the submucosal fibroelastic connective and the anal cushionsprotrude into the anal canal and may produce painless bleeding (firstdegree hemorrhoids). Prolapsed hemorrhoids lying outside the anal canalmay become strangulated by the internal sphincter activity with possiblethrombosis of the venous plexus (fourth-degree hemorrhoids). Thiscondition may result in gangrene with the risk of abscess formation.

Hemorrhoids can be of two types, external and internal. A ribbed dentateline is located about 2.5 to 3 cm in from the exterior of the anus andmarks the change from the anus to the rectum. Hemorrhoids are found inthe anal area before this line. Internal hemorrhoids generally are foundin the rectal area before this line and external hemorrhoids generallyare external of the anal ring. Internal hemorrhoids are generally formedfrom arteriovenous anastomoses or connections that reside in asubmucosal space within the wall of the rectum, approximately 2.5 to 5cm in from the exterior of the anus. Due to its proximity to the anus,internal hemorrhoids can protrude from the wall of the rectum in eitherone localized area, more than one localized area, or circumferentiallyaround the rectum and in certain severe cases, the internal hemorrhoidscan protrude out of the anus.

A wide variety of surgical methods have been suggested for the treatmentof severe internal hemorrhoids. One method is a closed hemorrhoidectomy.According to this method a retractor is inserted into the anus to obtainaccess to a hemorrhoidal site. The surgeon then clamps the hemorrhoidwith alligator clamps, ligates the vessels, and dissects the hemorrhoidfrom the rectal wall with a scalpel or scissors. Once the hemorrhoid isremoved, the surgical site is sutured closed. The retractor is thenrotated to another position and the remaining hemorrhoids are treated ina similar manner until all of the hemorrhoids have been removed.

Another method for the removal of internal hemorrhoids is an openhemorrhoidectomy. According to this procedure, rather than using aretractor, the anus is gently dilated with two fingers and forceps areplaced at the mucocutaneous junction of each primary hemorrhoid. Thehemorrhoids are pulled down and a second forceps is applied to the mainbulk of each hemorrhoid to produce “a triangle of exposure”. Next, theclamped, hemorrhoid is dissected from the sphincter muscle and isdissected proximally as far as the pedicles and then ligated or tied.Unlike the closed procedure, the wound is not sutured closed, but isleft open with a light dressing applied to the wound.

Yet another hemorrhoidectomy procedure involves excising hemorrhoidaltissue above the dentate line and excising and suturing the redundantrectal mucosa to the anoderm. This procedure is particularly used inconjunction with circumferential hemorrhoids.

In a paper by Dr. G. Allegra entitled “Particular Experience withMechanical Sutures: Circular Stapler for Hemorrhoidectomy,” presented tothe 1.sup.st. National Conference of the Italian ViscerosynthesisAssociation in May 28-30, 1989, and published in GIORN Chir. Vol. 11-No.3-pp 95-97, March 1990, Dr. Allegra disclosed a simpler and fastermethod for performing a hemorrhoidectomy. The paper discloses the use ofa conventional circular stapler to perform a hemorrhoidectomy on secondand third degree hemorrhoids. According to the procedure detailed by Dr.Allegra, the anus is dilated to place a continuous submucosal circle ofsutures at the base of the pectinate or dentate line. Next, the endeffector of a conventional circular stapling instrument is opened andplaced into the anus of a patient such that the anvil assembly of thestapling end effector is distal of the suture ring and the stapling headassembly (of the stapling end effector) is proximally outside of thepatient. This placement enables the surgeon to reach within the anus inorder to grasp the loose ends of the suture. The loose ends of thesuture are then pulled to draw the circle of suture closed and to drawthe hemorrhoidal tissue in around the anvil shaft which connects theanvil to the stapling head assembly of the circular stapling instrument.Next, the surgeon closes the anvil upon the hemorrhoidal mass and thestapler is fired to perform the hemorrhoidal transection. Once fired,the circular stapling instrument is removed from the anus with thetransected hemorrhoids captured within.

One limitation of Dr. Allegra's procedure is that the stapling headassembly must be placed proximally outside of the patient to enable thesurgeon to grasp the loose ends of the suture and to draw the suture outof the anus through a gap between the anus and the stapling headassembly. The gap between the anus and the stapling head assembly isneeded to permit withdrawal of the suture from the anus and thus limitsthe depth that the stapling end effector can be placed into the anus.Using Dr. Allegra's procedure, if the hemorrhoids are located deeperinto the anal canal, as in the case of internal hemorrhoids, thestapling head assembly enters the anus and effectively blocks thesurgeon from accessing the loose ends of the suture.

An additional limitation of Dr. Allegra's procedure is the amount ofhemorrhoidal tissue that can be drawn into the stapling end effector ofa conventional circular stapling instrument. Hemorrhoids are drawn intoand around an anvil shaft (connecting the open anvil assembly to thestapling head assembly) by tightening a continuous loop of suture placedbelow the dentate line. This action draws the hemorrhoids around theanvil shaft but does not draw the hemorrhoids into the inner chamber ofthe stapling head assembly. This limits the amount of hemorrhoidaltissue that can be brought into the stapling end effector and thesurgeon may remove only part of a hemorrhoid.

U.S. Pat. No. 6,083,241, to Longo et al. also discloses a method forremoving internal hemorrhoids from a patient using a circular stapler. Asuture is placed into or above the internal hemorrhoids of the patient.A needle hook is employed to grasp the suture and withdraw the suturethrough a passageway in the stapling head assembly and out of the casingof the stapling head assembly. The circular stapling instrument isclosed and then fired in order to staple and cut the hemorrhoidal tissueand the stapling instrument is removed from the patient to remove thetissue from the patient.

A significant drawback of both the Dr. Allegra and the Longo et al.procedures is the complexity of the procedures. Each calls for thehemorrhoidal tissue to be sutured, prior to stapling and cutting. Thissignificantly increases the time of performing the procedure and in turnincreases the potential for complications and the potential for traumato the patient. As described above, each procedure generally requiresthat a purse string type suture be first sewn into the tissue by using aretractor to expose a portion of the tissue; suturing the exposedportion of the tissue; repositioning the retractor adjacent the suturedportion and repeating these steps around the circumference of the rectalcavity until the entire tissue has been sutured.

Thus, the need exists for surgical staplers and/or apparatus which areless complex and can more quickly perform a surgical procedure thanexisting surgical staplers. In addition, the need exists for staplersand/or apparatus which reduce the trauma experienced by the patientduring the surgical procedures described above. Further, the need existsfor methods of performing the above described surgical procedures whichare less complex and less time consuming than existing methods ofperforming the same.

SUMMARY

In accordance with the present disclosure, a circular surgical staplingapparatus is provided in combination with a vacuum device. The vacuumdevice may be formed integrally with or incorporated into the surgicalstapling apparatus. Alternately, the vacuum device may be removably orfixedly secured to the surgical stapling device.

In one preferred embodiment of the present disclosure, a vacuum deviceis secured to the shell assembly of a surgical stapling apparatus. Thevacuum device may be secured to the shell assembly of a surgicalstapling apparatus by a resilient collar or band such that a source ofvacuum is communicated with the vent holes in the shell assembly. It isalso contemplated that the vacuum device may be secured directly to oneor more of the vent holes of the shell assembly or that the vacuumdevice may include a vacuum chamber positioned about the shell assemblyof the surgical stapling apparatus. In another preferred embodiment, oneor more vacuum tubes are provided in the vacuum chamber. Each vacuumtube has a first end positioned with the vacuum chamber and a second endpositioned within the inner chamber of the shell assembly. Preferably,the first end of each vacuum tube is supported on a slidable manifoldwhich is connected to a remotely located finger actuator. The fingeractuator is actuable to reposition the second end of each vacuum tubefrom a location within the inner chamber of the shell assembly to aposition external of the shell assembly.

In yet another preferred embodiment of the present disclosure, means fordrawing a vacuum is incorporated into the surgical stapling apparatus.In one preferred embodiment, a vacuum channel is provided through theelongated body and shell assembly of the surgical stapling apparatus.One end of the vacuum channel communicates with vacuum openings formedin the anvil shaft of the surgical stapling apparatus and the other endof the vacuum channel communicates with a source of vacuum may be anexternal source or a self-contained unit positioned within the surgicalstapling apparatus. The vacuum openings in the anvil shaft may have anydesired configuration.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will be further described with reference to theaccompanying drawings, wherein like reference numerals refer to likeparts in the several views, and wherein:

FIG. 1 is a side perspective view of a conventional circular surgicalstapling apparatus;

FIG. 2 is a side cross-sectional cutaway view of the distal end of thecircular surgical stapling apparatus shown in FIG. 1 with one preferredembodiment of the presently disclosed vacuum device or collar positionedabout a portion of shell assembly;

FIG. 2A is a side perspective view of the vacuum collar shown in FIG. 2with a portion of the vacuum conduit cutaway;

FIG. 3 is a side cross-sectional cutaway view of the distal end of thecircular surgical stapling apparatus shown in FIG. 1 with anotherpreferred embodiment of the presently disclosed vacuum device secured tothe shell assembly thereof;

FIG. 4 illustrates a side cross-sectional cutaway view of the distal endof a circular surgical stapling apparatus positioned within the anusincluding a preferred means for drawing a vacuum within the shellassembly;

FIG. 5 illustrates a side cross-sectional cutaway view of the distal endof a circular surgical stapling apparatus positioned within the anusincluding another preferred means for drawing a vacuum with in the shellassembly;

FIG. 6 illustrates a side cross-sectional cutaway view of the distal endof a circular surgical stapling apparatus positioned within the anusincluding another preferred means for drawing a vacuum within the shellassembly;

FIG. 7 is a side cross-sectional cutaway view of a circular surgicalstapling apparatus shown in FIG. 1 positioned within the anus withanother preferred embodiment of the presently disclosed vacuum devicesecured to the shell assembly of the surgical stapling apparatus;

FIG. 8 is a side cross-sectional cutaway view of the circular surgicalstapling apparatus shown in FIG. 1 with yet another preferred embodimentof the presently disclosed vacuum device, in a non-deployed position,secured to the shell assembly of the surgical stapling apparatus;

FIG. 9 is a top view of the surgical stapling apparatus shown in FIG. 8with the anvil assembly removed;

FIG. 10 is a side cross-sectional cutaway view of the surgical staplingapparatus shown in FIG. 8 with the vacuum device in the deployedposition; and

FIG. 11 is a side cross-sectional view of the circular staplingapparatus shown in FIG. 1 with another preferred embodiment of thepresently disclosed vacuum device, in a deployed position, secured tothe shell assembly of the surgical stapling device.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Preferred embodiments of the presently disclosed surgical apparatus willnow be described in detail with reference to the drawing figures whereinlike reference numerals identify similar or identical elements. In thedrawings and in the description which follows, the term “proximal”, asis traditional will refer to the end of the surgical apparatus which isclosest to the operator, while the term “distal” will refer to the endof the device which is furthest from the operator. While the followingdescription of the surgical apparatus and method will relate mainly tothe removal of rectal mucosal tissue from a patient, it is envisionedthat the apparatus according to the present disclosure is not limited tothe removal of the rectal mucosal tissue and can be used to performadditional or other surgical procedures.

In the present disclosure, the term “rectal mucosectomy” is understoodto include rectal-cuff-mucosectomy, circular stapler anopexy,hemorrhoidectomy, anastomosis, colonectomy and any other surgicalprocedure involving the mucosal wall of a lumen of the body. The term“staple” or “fastener” as used in the present disclosure, includessingle or multi-part, e.g., two-part, surgical fasteners, surgicalstaples, and the like.

It is also noted that a variety of circular surgical stapling apparatusare well known. Although the present disclosure illustrates onepreferred circular stapling apparatus, it is envisioned that theteachings provided herein may be applied to any of the variety of knownstapling apparatus.

Referring initially to FIG. 1, a surgical stapling apparatus inaccordance with the present disclosure is generally designated as 100.Surgical stapling apparatus 100 is of a generally conventional structureand includes a yoke 102, an elongated body 104 extending from yoke 102,a shell assembly 107 configured and adapted to carry a cartridgeassembly 106 (FIG. 2) and defining an internal chamber 150 at a distalend thereof, and an anvil assembly 108 at a distal end of the apparatus100. Apparatus 100 has an approximation mechanism (not shown) extendingproximally from anvil assembly 108 through elongated body 104 to a wingnut 110 at a proximal end of apparatus 100, for moving anvil assembly108 in relation to cartridge assembly 106. In addition, a pair ofhandles 112 are mounted to apparatus 100, to be manually grasped by thesurgeon and moved towards each other as indicated by arrows “A” in FIG.1, in order to fire staples from cartridge assembly 106 towards anvilassembly 108 and to actuate an annular blade 130 movably positionedwithin shell assembly 107. A safety lock 114 is also mounted on theproximal end of yoke 102. Safety lock 114 prevents inadvertent movementof handles 112 towards each other to prevent premature firing of thestaples or actuation of the annular blade. As is known in the art, oneor more suitable venting holes 116 are provided in conical section 118of shell assembly 107 for venting the interior of cartridge assembly106. In accordance with one embodiment of the present disclosure, theseand/or other vent holes or apertures can be employed or provided forproviding a vacuum to the interior or inner chamber 150 (FIG. 2) ofshell assembly 107. Other known surgical stapling apparatus aredescribed in commonly assigned U.S. Pat. No. 5,915,616 to Viola et al.and PCT International application No. PCT/US02/10792, filed Apr. 3,2002, the entire disclosure of each of which is incorporated herein byreference. Copending application entitled “Surgical Stapler ApparatusAnd Method” filed under Express Mail Mailing Label No. EV149022962USfiled on an even date herewith is also incorporated herein by referencein its entirety.

Referring to FIG. 2, generally, circular surgical stapling apparatusinclude an anvil retainer 120 for securing an anvil shaft 122 of theanvil assembly 108 (FIG. 1) to an approximation mechanism of surgicalstapling apparatus 100. The approximation mechanism is actuable, e.g.,via wing nut 110, to reciprocate anvil retainer 120 within elongatedbody 104 and, thus, reciprocate anvil shaft 122 within elongated body104 and shell assembly 107. Reciprocation of anvil shaft 122 withinelongated body 104 effects movement of anvil assembly 108 in relation toshell assembly 107 between spaced and approximated positions. A pusherassembly is also provided which includes a pusher back 124 and a stapledriver 126. Pusher back 124 is moved within elongated body 104, e.g.,via operation of handles 112, to advance staple driver 126 and annularknife blade 130 through cartridge assembly 106 to eject staplers orfasteners 128 from cartridge assembly 106 and cut tissue.

Referring now to FIGS. 2 and 2A, in one preferred embodiment of thepresently disclosed circular stapling apparatus 100, a vacuum deviceincluding a resilient or elastic collar or band 140 is provided whichincludes an annular resilient band body 142 and a flexible vacuumconduit 144. Vacuum conduit 144 has a first end which communicates witha port 146 formed in band body 142. A second end (not shown) of conduit144 is adapted to communicate with a source of vacuum. Vacuum conduit144 can be integrally formed with band body 142 or in the alternativesecured to band body with a suitable connector, e.g., threads,interlocking structure, etc. Resilient band 142 is preferably formed ofan elastomer neoprene or a natural or synthetic rubber, although otherresilient and non-resilient materials may be used. Band 142 isdimensioned to be received preferably tightly about conical section 118of shell assembly 107 such that port 146 of band body 142 communicateswith preferably one or more a venting holes 116 and/or other aperture(s)or clearance(s) in shell assembly 107. Remaining venting holes 116 arefluidly sealed by band body 142.

In use, when the distal end of apparatus 100 is positioned within alumen, e.g., the anus, and a vacuum is drawn through vacuum conduit 114and port 146 in band body 142, a low pressure region or vacuum iscreated within inner chamber 150 defined in shell assembly 107. Thisvacuum or low pressure region causes tissue, e.g., the mucosal wall ofthe lumen, to be sucked or drawn into inner chamber 150 of shellassembly 107 about anvil shaft 122. Thus, when apparatus 100 isapproximated, i.e., anvil shaft 122 is retracted into elongated body104, tissue is trapped between anvil assembly 108 and cartridge assembly106. Thereafter, apparatus 100 can be fired in the manner set forthabove to staple and sever tissue.

Referring to FIG. 3, it is also contemplated that vacuum conduit 144 canbe attached to a venting hole and or other apertures or clearances 116using means other than a resilient band. For example, a connection,e.g., a screw fitting 152, a quick disconnect fitting, a frictionfitting, etc., on either or both members to be directly or indirectlyconnected may be used to attach vacuum conduit 144 to, or communicatewith, one or more holes 116 (one shown). The remaining holes 116 can besealed using any known technique or, in the alternative, apparatus 100may be provided with only a single hole 116.

FIGS. 4-11 illustrate various alternative embodiments of the presentlydisclosed circular stapling apparatus, each including a different meansfor applying or drawing a vacuum in the inner chamber of the shellassembly. Although many of the embodiments illustrated herein include anexternal vacuum source, it is envisioned that each apparatus describedabove can be configured and adapted to include a self-contained vacuumunit, e.g., a vacuum unit may be contained within the handle assembly orelongated body of the circular stapling apparatus. Each of the disclosedcircular stapling apparatus may also be adapted to be incorporated intoa robotically controlled, remotely actuated system. Thus, the vacuumsource can be operated remotely or located in a remote unit or controlbox, as in a robotic system.

Referring to the embodiment of the circular stapling apparatus shown inFIG. 4, a vacuum channel 160 is provided through pusher back 124, anvilretainer 120 and anvil shaft 122. Depending on the particular stapler,these components may be hollow or solid. If the components are solid,channel 160 must be formed, i.e., molded or drilled, in the particularcomponent. One or more vacuum openings 162 are provided in anvil shaft122. Where only a single opening 162 is provided in anvil shaft 122, theopening should preferably be located in or near inner chamber 150.Openings 162 maybe circular, oval, elongated channels 162 a (FIG. 5), orany other configuration which permits air flow. A vacuum source (notshown) is fluidly connected to vacuum channel 160. As discussed above,the vacuum source may be external or a self-contained vacuum unit (notshown) supported in the handle assembly or elongated body of theapparatus. If an external vacuum source is provided, an inlet port (notshown) may be provided in the apparatus at any location proximal ofanvil retainer 120 which communicates with vacuum channel 160. Asdiscussed above with respect to FIG. 2, when a vacuum is drawn throughvacuum channel 160, a low pressure region 166 is created in the innerchamber 150 of shell assembly 107 and in the area between shell assembly107 and anvil assembly 108. This low pressure region functions to drawtissue from the inner walls 170 of the lumen about anvil shaft 122 ofanvil assembly 108 and into inner chamber 150 of shell assembly 107.Tissue can then be severed and fastened in the manner discussed above.

The circular stapling apparatus shown in FIG. 6 is similar to theapparatus shown in FIGS. 4 and 5 in that vacuum channel 160 is providedthrough pusher back 124, anvil retainer 120 and anvil shaft 122.However, vacuum channel 160 also includes an annular series of radialports 160 a formed through anvil shaft 122, which ports preferably arepositioned within inner chamber 150 of shell assembly 107 when anvilassembly 108 and cartridge assembly 106 are in spaced relation. Theapparatus operates in a manner similar to that described above. In thisand other embodiments herein, ports can be fed by radial passagewaysextending from a main vacuum channel extending through anvil shaft 122.

Referring to FIG. 7, the vacuum device may include a hollow sleeve 180which is positioned about the distal end of elongated body 104. Thesleeve 180 defines a vacuum chamber 182 and includes an outlet port 184which communicates with a vacuum tube 186. A distal end 180 a of hollowsleeve 180 is positioned over conical portion 118 of shell assembly 107′such that holes and/or other apertures or clearances 116 of shellassembly 107′ or shaft 104 are positioned within vacuum chamber 182. Assuch, when a vacuum is drawn through vacuum tube 186, a low pressureregion is created in vacuum chamber 182 and within inner chamber 150 ofshell assembly 107′ as well as in the space defined between shellassembly 107′ and anvil assembly 108. The low pressure region, asdiscussed above, draws mucosal tissue from the lumen walls 170 towardsanvil shaft 122 and into inner chamber 150 of shell assembly 107.

Shell assembly 107′ is substantially identical to shell assembly 107shown in FIGS. 2-6 except that the diameter of annular knife blade 130′has been increased to define a larger unobstructed area within innerchamber 150. Spaces between other surrounding elements of the cartridgeassembly radially exterior or outward of the annular knife blade 130′are preferably also compressed. As illustrated, the outer diameter ofannular knife 130′ is substantially equal to the inner diameter ofcartridge 106. As such, a greater amount of tissue can be severed andretained within shell assembly 107′ during use.

Referring to FIGS. 8-11, in addition to hollow sleeve 180, the vacuumdevice may include one or more vacuum tubes 200 which extend from withinvacuum chamber 182 through holes 116 of shell assembly 107′ into innerchamber 150 of shell assembly 107′. In one preferred embodiment, aplurality of vacuum tubes 200 are provided. Each vacuum tube includes afirst end 200 a secured to a slidable ring or manifold 202. Manifold 202is slidably supported within vacuum chamber 182 and is fastened to afinger actuator 204 by a link 206. Link 206 may be integrally formedwith manifold 202 and finger actuator 204. Alternately, these elementsmay be individually formed and secured together using known fasteningtechniques. Finger actuator 204 is slidable along an outer surface ofelongated body 104 to move manifold 202 and vacuum tubes 200 between aretracted (non-deployed) position (FIG. 8) and an advanced (deployed)position (FIG. 10). Although finger actuator 204 is shown positioned onthe elongated body 104, an appropriate linkage may be provided toposition the finger actuator adjacent handles 112 (FIG. 1). Guidestructure 210 may be provided within shell assembly 107′ to directvacuum tubes 200 through shell assembly 107′.

Vacuum tubes 200 are preferably formed from a flexible material, e.g.,plastic, rubber, metals, metal or plastic shape memory materials, etc. Asecond end of each vacuum tube 200 extends through a respective hole 116in shell assembly 107′ and is positioned within inner chamber 150 ofshell assembly 107′. The location of the second end 200 b of vacuum tube200 can be repositioned by moving finger actuator 204 in relation toelongated body 104 from a position within inner chamber 150 to aposition external of shell assembly 107′. It is envisioned that thelength of vacuum tubes 200 may be selected to facilitate positioning ofend 200 b of vacuum tubes 200 at any location from within inner chamber150 of shell assembly 107′ to anvil assembly 108. Vacuum tubes 200 mayalso be of a length to engage tissue positioned radially outwardly ofshell assembly 107′. In one preferred embodiment illustrated in FIG. 11,vacuum tubes 200′ are formed of a resilient or shape-memory materialwhich naturally curves radially outwardly of shell assembly 107′ whenvacuum tubes 200′ are moved towards the deployed position. Tubes 200 arepreferably of a length to engage tissue, e.g., mucosal tissue, definingthe inner wall of a lumen, e.g., the anus. Tubes 200 may be deployed toengage tissue and, then, returned to the non-deployed position to pulltissue into the shell assembly.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, the vacuum devices disclosedherein may be incorporated into a circular surgical stapling apparatusnot having vent holes in the shell assembly by providing a vacuumchannel though the shell assembly of the circular stapling apparatus.Therefore, the above description should not be construed as limiting,but merely as exemplifications of preferred embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

1. A surgical fastener applying apparatus comprising: a body portion; ashell assembly supported on a distal end of the body portion; an anvilassembly movable in relation to the shell assembly between spaced andapproximated positions, the anvil assembly comprising: an anvil member;and an anvil shaft extending proximally from the anvil member; a vacuumchannel extending into the anvil shaft; and at least one opening in theanvil shaft at a location spaced from the anvil member.
 2. A surgicalfastener applying apparatus according to claim 1, wherein the at leastone opening in the anvil shaft is configured as an elongated channel. 3.A surgical fastener applying apparatus according to claim 1, wherein theat least one opening in the anvil shaft includes a plurality ofopenings.
 4. A surgical fastener applying apparatus according to claim3, wherein the plurality of openings are spaced along a longitudinalaxis of the anvil shaft.
 5. A surgical fastener applying apparatusaccording to claim 3, wherein the plurality of openings are spaced abouta periphery of the anvil shaft.
 6. A surgical fastener applyingapparatus according to claim 1 further including a pusher assemblyconfigured and dimensioned for longitudinal movement through the bodyportion to facilitate ejection of a plurality of surgical fasteners fromthe surgical fastener applying apparatus.
 7. A surgical fastenerapplying apparatus according to claim 6, wherein the vacuum channelextends into the pusher assembly.
 8. A surgical fastener applyingapparatus according to claim 7, wherein the pusher assembly includespusher back and a staple driver, the pusher back and the stapler driverbeing in mechanical cooperation such that distal advancement of thepusher back causes distal advancement of the staple driver.
 9. Asurgical fastener applying apparatus according to claim 8, wherein thevacuum channel extends into the pusher back.
 10. A surgical fastenerapplying apparatus according to claim 9 further including a knife membermovable through the shell assembly, the pusher back and the knife memberbeing in mechanical cooperation such that distal advancement of thepusher back causes distal advancement of the knife member.
 11. Asurgical fastener applying apparatus according to claim 10, wherein theknife member is annular in configuration.
 12. A surgical fastenerapplying apparatus according to claim 1 further including an anvilretainer positioned within the shell assembly configured and dimensionedto receive the anvil shaft.
 13. A surgical fastener applying apparatusaccording to claim 12, wherein the vacuum channel extends into the anvilretainer.
 14. An anvil assembly for use with a surgical fastenerapplying apparatus, the anvil assembly comprising: an anvil member; andan anvil shaft extending proximally from the anvil, wherein the anvilshaft includes a vacuum channel in communication with a vacuum source,and at least one opening in the anvil shaft at a location spaced fromthe anvil member.
 15. An anvil assembly according to claim 14, whereinthe at least one opening is configured as an elongated channel.
 16. Ananvil assembly according to claim 14, wherein the at least one openingis circular in configuration.
 17. An anvil assembly according to claim14, wherein the at least one opening is oval in configuration.
 18. Ananvil assembly according to claim 14, wherein the at least one openingincludes a plurality of openings.
 19. An anvil assembly according toclaim 18, wherein the plurality of openings are spaced along alongitudinal axis of the anvil shaft.
 20. An anvil assembly according toclaim 18, wherein the plurality of openings are spaced about a peripheryof the anvil shaft.